Does Insurance Cover Acupuncture and How to Check

Some insurance plans cover acupuncture, but it's not a guarantee.

Check your policy to see if acupuncture is a covered service.

Many insurance providers require a doctor's referral before covering acupuncture treatments.

You can contact your insurance company directly to ask about their acupuncture coverage policies.

Some insurance plans cover acupuncture for specific conditions, such as pain management or stress relief.

Check your policy to see if these conditions are covered.

Most private health insurance plans have covered acupuncture for years, including big names like Aetna, Banner Health, Blue Cross Blue Shield, Cigna, Health Net, and United Healthcare.

Government-run insurance programs like Medicare and the Veteran's Administration also cover acupuncture, which was added to their benefits in 2020. Medicare provides health insurance to American citizens age 65 and older, as well as those with certain medical conditions or Social Security disability benefits. The Veteran's Administration provides healthcare to active duty and retired members of the U.S. armed services.

Acupuncture is recognized as a safe alternative to treat a variety of issues, including arthritis, headaches and migraines, ADD & ADHD, neck, back, and shoulder pain, sciatica, and stress and anxiety.

In addition to private and government-run insurance programs, federal employees now receive acupuncture benefits under their medical insurance as part of an effort to fight the opioid epidemic. The Centers for Medicare & Medicaid Services (CMS) announced that government programs would begin covering both acupuncture and chiropractic care to help patients avoid highly addictive pain pills.

To understand how your insurance covers acupuncture, check your health insurance plan's benefits or call our office and we'll work with you to verify your coverage. The types of acupuncture treatments covered by your insurance vary according to your policy.

Here's a breakdown of common insurance terms related to acupuncture:

The only way to know if your plan has an Acupuncture benefit is to contact the plan directly, as not all plans cover acupuncture, even some of the more expensive ones.

To determine if your health insurance plan covers acupuncture, you'll need to contact the plan directly. This is because not all plans cover acupuncture, and even some of the more expensive plans don't provide coverage.

You can check your plan's portal to see if acupuncture is listed as covered or not covered. However, if you don't see acupuncture listed, you'll need to call your health insurance company to ask about coverage.

Health insurance companies are specific about what conditions they will cover acupuncture for, and each company is different. For example, some plans may only cover acupuncture for back pain, while others may cover it for a variety of conditions.

To ensure coverage, you'll need to provide diagnosis codes for the condition you're seeking treatment for when submitting an acupuncture claim. If the diagnosis code isn't included or isn't one that's covered by the insurance company, the claim will be denied.

Here are some examples of conditions that may be covered by insurance:

Your health insurance plan may also have specific requirements for acupuncture coverage, such as requiring a referral from a primary care physician. Be sure to check your plan's benefits to understand how your plan covers acupuncture.

Medicare covers acupuncture for chronic low back pain, but with some limitations. Medicare limits coverage to 12 visits over a 90-day period.

Chronic low back pain is defined as lasting for at least 12 weeks and not being caused by surgery, pregnancy, or disease. This is according to CMS, the organization that runs Medicare.

You're also covered if you have a Medicare Advantage plan, which is an alternative to Original Medicare. Full details on Medicare's acupuncture coverage are available on Medicare.gov.

However, there's a catch: Medicare doesn't currently employ acupuncturists, so you can't directly bill them for acupuncture services. This is due to a limitation within the Medicare system itself, as explained by David LeGar.

The reason for this is that there are still 3 states in the U.S. that haven't officially recognized acupuncture as a medical practice. These states need to update their regulations for Medicare to employ acupuncturists and provide coverage.

If you're wondering if your insurance covers acupuncture, the first step is to check if your plan has coverage. Not all plans cover acupuncture, even some of the more expensive ones don't provide coverage.

To determine if your plan covers acupuncture, you can check your plan's portal or contact the plan directly. Most plans have a portal where you can log in and see your coverage, but if you don't specifically see acupuncture listed as covered or not covered, you'll want to call your health insurance company and ask if you have an acupuncture benefit included with your health plan.

It's also important to note that provider lists are not a confirmation of coverage, so just because a provider is listed for your plan, it doesn't mean you have coverage.

Here are some insurance providers that may cover acupuncture, but it's not a guarantee: Blue Cross Blue Shield, United Healthcare, and Aetna. If you're unsure of your coverage, it's always best to check with your provider.

If your plan does cover acupuncture, your out-of-pocket expenses will fall into one of two scenarios: you'll owe a designated copay amount, usually between $20 and $40, or you'll owe an amount dependent on your deductible.

Some insurance plans place a limit on the number of treatments that are covered per calendar year, so be sure to check with your provider to see if there are any limitations on your coverage.

Acupuncture is recognized as a safe alternative to treat a variety of issues, including arthritis, headaches and migraines, ADD & ADHD, neck, back, and shoulder pain, sciatica, and stress and anxiety.